A small clinical study suggests that allopurinol can offset some of the damage caused by obstructive sleep apnea.
Snoring and daytime sleepiness can often be traced back to obstructive sleep apnea – a condition in which a collapse of the soft palate tissues impedes the free flow of breathing. In fact, the person actually stops breathing momentarily many times in the night and the resulting oxygen deprivation has been linked to high blood pressure and heart disease.

In a study, researchers at the University of Buffalo in the USA gave the gout drug allopurinol or placebo for two weeks to a group of 12 patients with sleep apnea. The drug blocks an enzyme called xanthine oxidase which otherwise triggers damage to the blood vessels during oxygen deprivation. Those on allopurinol showed an improvement in blood vessel functioning and a lowering of oxidative damage. Nor were there any side effects. The researchers now hope to carry out further work with allopurinol in sleep apnea to determine the best dosage and duration of treatment.
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There is a frequently overlooked factor that can cause an acute increase in the concentration of uric acid in the blood as well as increased likelihood of its precipitation as MSU (monosodium urate or uric acid crystals. See, Gout Basics for background). That factor is the reduction of the concentration of oxygen in the blood, which occurs in an individual suffering from sleep apnea.

Sleep apnea is the repeated cessation of breathing for many seconds at a time during sleep, when the muscles lining the airway relax enough to allow it to close, until the brain jolts them to reopen. The resulting reduction of oxygen in the blood causes the cells in the body to undergo a process of disintegration, which leads to their generation of excess uric acid. Once the uric acid is formed, the process is irreversible, even when breathing restarts. With each apneic period, more and more uric acid is fed into the blood, faster than the kidneys can dispose of it. Furthermore, the increased ratio of carbon dioxide to oxygen in the blood makes the blood more acidic, so that its ability to hold uric acid in solution is reduced and MSU is more likely to precipitate. These processes were described in medical journal literature about twenty years ago, and subsequent literature has confirmed that sleep apnea leads to excess uric acid in the blood and in the urine.

Thus, sleep apnea hits gout attacks with a double whammy. It feeds more uric acid into the blood plus it reduces the ability of the blood to hold the uric acid in solution so that MSU precipitates. The result is a gout attack that develops while sleeping.

This dysfunctional blood chemistry begins to resolve after the sleeper awakens, when the apneic periods cease and the kidneys have time to catch up in their removal of uric acid from the blood. Thus, a blood test of uric acid taken several hours after awakening will often measure as normal. The excess uric acid occurs as a flare that the belated blood test never detects.

The factors for increased risk of developing gout – heredity, overweight, alcohol use, middle or elderly age, male gender, female gender past menopause – are all the same increased risk factors for developing sleep apnea. But those who do not fall into these categories can develop either condition. It’s just less likely. I am not overweight, and I never was. Yet I developed both in middle age. Now I have neither.

Where Are The Data?

One would think that in the twenty-year period since these physiologic processes were described, gout researchers would have conducted studies to determine what percentage of gout sufferers also have sleep apnea, and in what percentage of those does resolving the sleep apnea cure their gout. It hasn’t happened. One can only speculate as to why, and some speculated conclusions may have a very cynical view of gout experts. What has been reported recently is a long list of serious diseases that have been found to have a strong association with elevated uric acid, but with no recognition given that all these diseases have previously been shown to be consequences of sleep apnea.

I realized the sleep apnea/gout connection over five years ago when resolving my sleep apnea resulted in the complete cessation of my gout attacks. And I know that I am not the only one who has observed that result. Based on my information, my primary care physician has been screening all his gout patients for sleep apnea. He has found that a large majority of them have sleep apnea, when neither he nor they would have otherwise suspected it.

Why This Is So Important

The results found by my literature search and by my primary care physician have convinced me the sleep apnea is a major cause of gout attacks. I have the view that all gout sufferers should assume they have sleep apnea as the underlying cause of gout until proven otherwise. That means that all gout sufferers should be screened for sleep apnea, not only to cure their gout, but more importantly to prevent the development of much more serious diseases.

Resolving gout is important. Even more important is diagnosing and resolving sleep apnea. Gout is very painful, but by itself it is not life threatening. If left untreated, sleep apnea is known to have numerous consequences that are life threatening – heart attack, heart arrhythmias, heart failure, stroke, diabetes, depression, kidney disease, and many other maladies. It is no wonder that this list matches closely the list of associations with hyperuricemia presented in the Is Gout Dangerous? posting on this website, because hyperuricemia is a direct consequence of sleep apnea. A fourteen-year study in Australia of people with sleep apnea who refused treatment concluded that the life expectancy of these people was 18 years shorter that of the general population, a conclusion that stunned even the study’s researchers.

Unfortunately, palliating your gout by using NSAIDs or prescription drugs does nothing to overcome your sleep apnea. It just masks the warning until one or more of the dire consequences of sleep apnea smacks you. In my case it was a transient ischemic attack (ministroke), atrial fibrillation heart arrhythmia, and diabetes, all of which I have recovered from. I was lucky that my sleep apnea consequences turned out to be reversible, but I have to maintain a strict diet to prevent the return of my diabetes.

There are about 80 times as many people with sleep apnea as there are with gout. Ironically, those of us with gout may be the fortunate ones because we have an early warning of our sleep apnea, but only if we and our doctors know about the connection.

A recent study performed in Australia of the medical records of over 16,000 patients diagnosed with obstructive sleep apnea found that gout was present in about 5% of them. Other sources estimate that the prevalence of gout in Australia is .27% of the population. That means that in Australia the likelihood of gout is 19 times higher in people with sleep apnea vs. the general population. Statistics for other first world countries are probably very similar.
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The above post may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. The material available is intended to advance the understanding of Sleep Apnea treatment and to advance the educational level of Sleep Apnea patients with regard to their health. Sometimes included is the full text of articles and documents rather than a simple link because outside links frequently "go bad" or change over time. This constitutes a "fair use" of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this post is distributed without fee or payment of any kind for research and educational purposes. If you wish to use copyrighted material from this post for purposes of your own that go beyond "fair use", you must obtain permission from the copyright owner.

I started getting gout when I was 30 years old...saw 3 different Drs over the next decade while having gout attacks at least a dozen times..one even had me pee in a jug over 3 days several times then said i was a Uric acid secreter...but did nothing to treat me..not even for the pain?!

Finally another new Dr. said "lets try allopurinol 300mg?" since that time 3 years ago I have had the onset of gout many times but no more full blown gout attacks..interestingly almost every attack I have ever had was just there, appeared out of the blue overnight after waking up in the morning..the last one was just a month ago and the lingering pain lasted about 12 days..lots and lots of anti-inflammatory ibuprofen was ingested those 2 weeks

Your posts were very informative and I think on the right track.

I have been using this PRS1 for 3 weeks now and my AHI is sub 2.0, so will be interesting to see if the smaller less painful onset gout attacks I still endure (stiffness and pain in my big toe joint and ankle pain) stops all together now

I am interested in this topic. I've been taking allopurinol since earlier this year because my Uric Acid levels were elevated 8.3. I've never had a gout attack unless an gout attack can be very mild. At about the same time that I started the allopurinol I started my CPAP treatment. Now after 3 or 4 months my Uric Acid is down to 5.6. Isn't below 5 considered normal??

My Dr. said , any reading over 5 can give you a gout attack...think the scale goes 0-9
when he did my blood work it came back at 6.3...and thats with me taking the high dose of allopurinol everyday.,

And gout attacks can be mild..cause joint damage without you even knowing...Mine have always been painful..even the milder ones. It can be hereditary I guess cuz I found out both my father and grandfather had it also

I developed gout in my early 30's; at the time my doc recommended that I quit eating organ meat, cut down on the consumption of beer and eat better balanced meals (working on the road and eating out three meals a day was not conducive to eating healthy). Or, I'd be on allopurinol for the rest of my life.

I staved off the drug treatment for about 25 - 30 years by changing some of my "consumption" habits; however, something changed and I've been on the drug now, for about 5 years. I only have flair-ups if I drink more than one beer a day or eat an excessive amount of rich food.

I have not noticed any changes in my OSA since going on allopurinol. I may have seen something if I'd been using a data machine at the time I started taking the drug.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.